{"id":67384,"date":"2025-09-30T10:10:36","date_gmt":"2025-09-30T10:10:36","guid":{"rendered":"https:\/\/biomedpharmajournal.org\/?p=67384"},"modified":"2025-10-04T06:17:06","modified_gmt":"2025-10-04T06:17:06","slug":"determination-of-cystatin-c-and-creatinine-s-in-sudanese-patients-with-chronic-kidney-disease","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol18no3\/determination-of-cystatin-c-and-creatinine-s-in-sudanese-patients-with-chronic-kidney-disease\/","title":{"rendered":"Determination of Cystatin C and Creatinine S in Sudanese Patients with Chronic Kidney Disease\u00a0"},"content":{"rendered":"

Introduction \u00a0<\/strong><\/p>\n

The chronic kidney disease (CKD), and end-stage renal diseases (ESRD) are main \u00a0health concerns affects all nation worldwide with gradual \u00a0raising rates \u00a0and prevalence.1<\/sup><\/p>\n

CKD predominately having no symptoms, and thus, a laboratory estimation \u00a0of renal function is needed. the most parameter used to assess CKD were , serum creatinine as crucial \u00a0indicators of glomerular filtration (GFR).2<\/sup><\/p>\n

Serum creatinine level have low sensitivity to early predict CKD and unable to predict half of patients in stage three CKD (GFR of 30-59 mL\/min\/1.73m2),3<\/sup> \u00a0<\/sup>in which serum creatinine level \u00a0may not change until approximately 50% of the kidney function has been changes .4<\/sup>In addition, creatinine production is also affected \u00a0by factors like \u00a0age, gender, muscle mass, physical activity and dietary intake.5<\/sup> Moreover, many factors encountered with measurements of creatinine and its use as a GFR estimate, cystatin C (CysC) has been proposed as an alternative marker of renal function. 5<\/sup><\/p>\n

Cystatin c recently has emerged as biomarkers for assessing the renal function, especially in the context of dialysis. Moreover, cystatin C was demonstrated to estimate GFR with better adequacy than creatinine in many studies 6-7<\/sup><\/p>\n

Beside traditional markers such as serum creatinine, cystatin C is a small, non-glycosylated protein produced at a constant rate by all nucleated cells and is freely filtered by the glomerulus. In addition , serum levels of cystatin C is \u00a0primarily determined by glomerular filtration rate (GFR), making it a reliable indicator of kidney function. 8<\/sup><\/p>\n

In dialysis, accurate assessment of renal function is crucial for monitoring disease progression, optimizing treatment strategies, and predicting outcomes. Conventional dialysis assessment parameters such as (Serum creatinine), may be influenced by factors such as muscle mass, diet, and medications, leading to variability in the test interpretation. Cystatin C, on the other hand, is less influenced by extra-renal factors and has been shown to provide a more adequate and accurate \u00a0estimation of GFR in patients with end-stage renal disease (ESRD).9<\/sup><\/p>\n

Many studies have been demonstrated the utility of cystatin C as a dialysis biomarker, with elevated levels correlating with reduced GFR and increased mortality risk in dialysis patients.10-11<\/sup> Furthermore, cystatin C has shown promise in identifying early renal dysfunction and predicting progression to ESRD, allowing for timely intervention and improved patient outcomes.12<\/sup><\/p>\n

In addition to its role in assessing renal function, cystatin C is considered as \u00a0potential marker of cardiovascular risk in dialysis patients. High level of cystatin C have been associated with cardiovascular diseases , including myocardial infarction, stroke, and heart failure, independent of traditional risk factors.13<\/sup>All these make \u00a0cystatin C as a biomarker, encompassing both renal and cardiovascular health in the dialysis population.<\/p>\n

Despite this roles, several challenges remain in the clinical implementation of cystatin C as a dialysis biomarker. Standardization of assay methods, establishment of reference ranges, and consideration of patient characteristics are essential for accurate interpretation of cystatin C levels.14<\/sup><\/p>\n

Here in this study we estimated the cystatin level beside conventional dialysis estimator(creatinine level) pre and post haemodialysis to detect reduction ratio.<\/p>\n

Materials and Methods <\/strong><\/p>\n

A cohort study was done in White Nile State,Al\u00ad\u00ad_Dieum city Al\u00ad\u00ad_Dieum Dialysis Center, from 28May to 4June 2017, forty patient on dialysis was selected for this study to determine the level of cystatin C and creatinine after dialysis. Total 40 heamodialysis\u00a0 Patients, age ranged from (15-70) years were selected for this study while patients with severe illness were excluded , Questioner was used to obtain initial information about the Heamodialysis\u00a0 Patients, The study was approved from ALzaeim Alazhari University faculty of medical laboratory sciences with code (1\u20140017) , blood was collected after by standard methods after patient informed about the aim of the study and consented to contribute to this study. 3 ml heparinized blood samples\u00a0\u00a0 heparin\u00a0 blood samples were collected from the patients\u00a0 and centrifuged and frozen in -20 and cystatin C was estimated within one week duration of storage in I Chroma, serum creatinine and urea was estimated by spectrophotometer , all test was performed under quality control protocol , the reduction was used with published formula reduction ratio =100*(1-( post test result\/ pre test result) we used this formula for all creatinine and urea and cystatin C<\/p>\n

Ethical approval and consents <\/strong><\/p>\n

The study approved from Alzaeim Alazhari\u00a0 University faculty of medical sciences with ethical committee code (1-0017)all patient signed informed consents\u00a0\u00a0 after informed about the aim of the study and consented to contribute to this study<\/p>\n

Data analysis<\/strong><\/p>\n

The data was entered and analyzed\u00a0 social package of social sciences version 20 SPSS\u00a0 p.value <0.050 valued as significants<\/p>\n

Results <\/strong><\/p>\n

Of 40 study participants 20 were males and 20 were females , the most patients were more than 50years old 45.5% , 42.5% between 25-50years while 12.5% were less than 25 years .The mean and STD of creatinine and cystatin c were reduced significantly in post haemodialysis than pre haemodialysis p.value 0.000. The haemodialysis\u00a0 reduction ratio were 14.93%(pvalue 0.000) , and 58.50% (p.value0.000) for cystatin C and creatinine respectively table(1).\u00a0 The higher reduction rate were achieved in females creatinine 60.29972% table (1). The pre and post haemodialysis cystatin c were not correlated with haemodialysis duration in years while pre haemodialysis creatinine\u00a0 level were significantly correlated with duration p.value 0.009 table(2) and figure (1).<\/p>\n

Table 1: Show statistics and mean differences of Cystatin C and Creatinine in pre and post dialysis with reduction ratio<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n
Item<\/strong><\/td>\nParameter<\/strong><\/td>\nPre<\/strong><\/td>\nPost<\/strong><\/td>\nReduction ratio%<\/strong><\/td>\nP.value<\/strong><\/td>\n<\/tr>\n
Overall<\/td>\nCystatin C<\/td>\n6.6028\u00b1.87383<\/td>\n5.6164\u00b11.04928<\/td>\n14.93912<\/td>\n0.000<\/td>\n<\/tr>\n
Overall<\/td>\nCreatinine<\/td>\n8.4900\u00b12.18278<\/td>\n3.5230\u00b11.17077<\/td>\n58.50412<\/td>\n0.000<\/td>\n<\/tr>\n
Males<\/td>\nCystatin C<\/td>\n6.3965\u00b1.84368<\/td>\n5.4130\u00b11.15678<\/td>\n15.3756<\/td>\n0.000<\/td>\n<\/tr>\n
Creatinine<\/td>\n8.5524\u00b11.89806<\/td>\n3.6857\u00b1.85105<\/td>\n56.90449<\/td>\n0.000<\/td>\n<\/tr>\n
Females<\/td>\nCystatin C<\/td>\n6.7726\u00b1.88353<\/td>\n5.8305\u00b1.90414<\/td>\n13.91046<\/td>\n0.000<\/td>\n<\/tr>\n
Creatinine<\/td>\n8.4211\u00b12.51210<\/td>\n3.3432\u00b11.44916<\/td>\n60.29972<\/td>\n0.000<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Table 2: <\/strong>Correlation of duration in Cystatin C and creatinine pre\/post heamodialysis:<\/strong><\/p>\n\n\n\n\n\n
<\/td>\nCystatin C pre<\/strong><\/td>\nCystatin C post<\/strong><\/td>\nCreatinine pre<\/strong><\/td>\nCreatinine\u00a0 post<\/strong><\/td>\n<\/tr>\n
Duration (Year)<\/td>\nR value<\/td>\n.004<\/td>\n.231<\/td>\n.408<\/strong><\/td>\n-.188<\/td>\n<\/tr>\n
P value<\/td>\n.982<\/td>\n.157<\/td>\n.009<\/strong><\/td>\n.246<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n
\"\"<\/td>\nFigure 1: Showed the association between pre and post level of the tests A) Showed cystatin level pre-dialysis and duration in years B) Post dialysis Cystatin C and duration in years<\/strong>Click here to view Figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Discussion<\/strong><\/p>\n

In this study the\u00a0 reduction ratios of cystatin C and creatinine were\u00a0 measured from pre-dialysis to post-dialysis levels, which provide valuable insights into the efficiency of hemodialysis in removing these waste products from the bloodstream. Fist of all our study confirmed higher level of cystatin level in patient with CKD, as urea and creatinine impaired in CKD consequently the cystatin C was also impaired. Our study observed a significant decrease in cystatin C reduction ratio post-dialysis compared to pre-dialysis levels, whereas creatinine reduction ratio showed a substantial reduction both pre- and post-dialysis which is consistent with meta analysis\u00a0 that found cystatin c is reduced after hemodialysis.15<\/sup> Moreover lower reduction of cystatin C than creatinine have been proposed in many studies. 6-16 <\/sup>The observed decrease in cystatin C reduction ratio post-dialysis suggests a less efficient removal of this biomarker during the hemodialysis session. Cystatin C, being a low-molecular-weight protein, is freely filtered by the glomerulus and predominantly cleared through renal excretion. However, hemodialysis may not effectively remove cystatin C due to its larger size and protein-bound nature, resulting in a lower reduction ratio compared to creatinine.10<\/sup> This discrepancy highlights the limitations of cystatin C as a dialysis biomarker and underscores the need for alternative markers of renal function in the dialysis population.<\/p>\n

In contrast, creatinine reduction ratio exhibited a significant reduction both pre- and post-dialysis, indicating effective removal of this small molecule during hemodialysis. Creatinine, a byproduct of muscle metabolism, is readily filtered by the glomerulus and efficiently removed by hemodialysis, making it a standard marker for assessing dialysis adequacy.17 <\/sup>The observed decrease in creatinine reduction ratio post-dialysis reflects the successful clearance of creatinine from the bloodstream during the dialysis session.<\/p>\n

Interestingly, our findings are consistent with those of other studies that have reported a reduction in cystatin C levels post-hemodialysis compared to pre-hemodialysis levels. For example, Huang et.al 18<\/sup>\u00a0 observed a significant decrease in cystatin C levels following hemodialysis sessions in a cohort of nephrotic \u00a0patients. Similarly, another study \u00a0reported a decrease in cystatin C levels post-hemodialysis in patients on dialysis with high flux haemodialysis.19<\/sup> The differences between cystatin C reduction ratio and traditional markers such as \u00a0creatinine which is estimated here \u00a0highlights the need for alternative markers of renal function in hemodialysis patients. While urea and creatinine are small molecules that are readily cleared by dialysis, cystatin C may exhibit different clearance kinetics and removal efficiency due to its unique properties.11<\/sup> Physicians \u00a0should interpret cystatin C reduction ratio in conjunction with other markers and clinical parameters to assess dialysis adequacy and monitor renal function in hemodialysis patients until adjust their reference range and other factors affect cystatin reduction ratio.<\/p>\n

The discrepancy between cystatin C and creatinine reduction ratios underscores the complex dynamics of solute removal during hemodialysis. While creatinine serves as a reliable marker of dialysis adequacy, cystatin C may not accurately reflect changes in renal function or dialysis clearance due to its unique properties and clearance mechanisms.<\/p>\n

Conclusion<\/strong><\/p>\n

In conclusion, our findings highlight the differences in reduction ratios of cystatin C and creatinine pre- and post-dialysis, reflecting variations in their clearance kinetics and removal efficiency during hemodialysis. More \u00a0research is needed for assessing dialysis adequacy and monitoring renal function in dialysis patients.<\/p>\n

Acknowledgement <\/strong><\/p>\n

We would like to thanks all patients participate in this study head Departments clinical chemistry university of Alzaeim Alazhri University.<\/p>\n

Funding Sources<\/strong><\/p>\n

The author(s) received no financial support for the research, authorship, and\/or publication of this article.<\/p>\n

Conflict of Interest<\/strong><\/p>\n

The author(s) do not have any conflict of interest.<\/p>\n

Data Availability Statement<\/strong><\/p>\n

This statement does not apply to this article.<\/p>\n

Ethics Statement<\/strong><\/p>\n

This research did not involve human participants, animal subjects, or any material that requires ethical approval.<\/p>\n

Informed Consent Statement<\/strong><\/p>\n

This study did not involve human participants, and therefore, informed consent was not required.<\/p>\n

Clinical Trial Registration<\/strong><\/p>\n

This research does not involve any clinical trials.<\/p>\n

Permission to reproduce material from other sources<\/strong><\/p>\n

Not Applicable\u00a0<\/strong><\/p>\n

Author contributions <\/strong><\/p>\n